- Email: [email protected]
P7 Veterans:UK and skin cancer. Pay back time?
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Posters / British Journal of Oral and Maxillofacial Surgery 48 (2010) S25–S55
Results: 5 cases of facial lipodystrophy were treated with cheek and zygomatic area augmentation. 3 cases were treated for hemifacial atrophy. 1 case was treated for nasolabial fold correction. 1 patient had excision for a teratoma with resultant deformity and had been reconstructed previously with Radial forearm free flap and face lifts. 1 patient had neurofibromatosis in which the fat graft was unsuccessful. Good results were obtained using this technique with no major complications. Conclusions: Autologous fat transfer using the Colemans technique for facial soft tissue asymmetry is a safe and reliable technique. We recommend autologous fat transfer as a definitive or adjunctive treatment for facial soft tissue asymmetry. P4 Assessing the modes of saliva collection in irradiated oral cancer patients H. Kaur, A. Matthews, J. Risk, R. Shaw. University of Liverpool, UK Introduction: Early detection and treatment of oral cancer is essential in improving prognosis. Molecular biomarkers found in saliva can be used to predict, detect and monitor malignant transformation. Furthermore, with a local recurrence rate of 10%, and many of the oral cavity sites being disfigured after surgical treatment; many second primaries will go undetected. Therefore surveillance using genetic biomarkers in saliva is very appealing. Aim: To determine the most efficient mode of collecting saliva, giving a substantial yield and quality of DNA; from a population irradiated oral cancer patients. This group had demonstrated difficulty in providing saliva samples in the past due to xerostomia. Materials and Method: We investigated a new collection technique to this field; an oragene saliva sponge kit. Saliva was also collected using a mouthwash. Both collection methods were tested on 25 subjects. DNA was extracted using Oragene purifier and Qiagen columns, respectively. The two methods of saliva collection were compared using spectrophotometery, gel electrophoresis and polymerase chain reaction (PCR) amplification with b-actin primers. Results: The oragene sponge method provided a greater DNA yield (12.34 mg median) compared to the mouthwash (6.015 mg median). However, gel electrophoresis showed the mouthwash provided samples of a better quality. Both methods provided high molecular weight DNA, but the mouthwash samples contained lower free nucleotides and RNA contamination compared to the sponge samples. DNA from both methods showed the ability to produce PCR products. Conclusion: The oragene sponge method was the most efficient way of collecting saliva, from a population of irradiated oral cancer patients. P5 Dental management of head and neck radiotherapy patients H. Anziani, A. Burns, R.J. Banks. Sunderland Royal Hospital, UK Introduction: Radiotherapy can result in significant oral side effects and complications. The management of dental disease is more complicated and problems can cause a significant impact on quality of life. Therefore it is vital that all patients are rendered dentally fit prior to radiotherapy, receive sufficient preventative care and are closely followed up. Methods: A national survey was undertaken of all head and neck units in the UK to assess dental management for these patients. This
was augmented with a review locally of patients attending Sunderland Royal Hospital Head and Neck centre over a one year period. Patients were assessed via questionnaire to establish their experiences of dental care pre, peri and post radiotherapy treatment. MDT notes and radiographs were correlated with any recorded pre and post radiotherapy dental pathology, prevention and intervention. Results: The majority of patients at our centre received a dental assessment prior to commencement of their oncology treatment. Post treatment dental care of these patients is very variable. Results of our survey suggest that this pattern is reflected nationally. There would appear to be a correlation between the initial state of their dentition, their compliance, access to dental care and the post treatment morbidity suffered. Conclusion: Head and neck cancer patients often present with a neglected dentition. Dental care can be a challenge in terms of patient motivation, access, both physical and organisational with limited time available prior to treatment. This study highlights both the lack of dental care for these patients and highlights its importance. P6 Can early detection rates for cancer referred to an Oral and Maxillofacial Surgery Department be improved by consultant triage of referral letters? J. Breeze, V. Attargekar, C.E. Moss, A.J. Gibbons. Peterborough District General Hospital, UK Aim: To analyse the detection rate of oral cancer from referrals to our department and if our department policy of triaging referrals was appropriate. Material and Methods: The authors reviewed all oral cancer referrals and urgent oral lesion referrals to the Department of Oral and Maxillofacial Surgery at Peterborough and Stamford NHS Foundation Trust Hospitals during 2006. Results: 63 patients were referred in 2006 for lesions that consultant triage suspected may be malignant or referred to be seen urgently. 33 patients were referred by General Practitioners and all were subsequently seen within the 2-week rule. Consultant triage of referral letters allocated a further 17 to been seen under the 2-week rule timescale. An additional 13 urgent referrals were classified as not meeting the 2-week rule criteria by the consultant that graded the letter but to be seen within four weeks. Conclusion: Our study shows that with consultant triaging of referral letters a malignancy detection rate of 24% can be achieved. P7 Veterans:UK and skin cancer. Pay back time? R. Pilcher, M.J.C. Davidson, M. Blanco-Guzman, J.F. Hamlyn, G.D. Merrick. Musgrove Park Hospital, Taunton, UK We aim to raise awareness for a compensation scheme for exservice personnel. Skin damage resulting from excessive sun exposure during their military service abroad may manifest itself many years later. Squamous cell carcinoma, basal cell carcinoma and melanoma arising in later life are part of the price veterans may pay for having served their country. At Musgrove Park Hospital, Taunton we routinely ask about previous military service abroad and hand out when appropriate the Veterans:UK pamphlets. These have the information required to gain advice and seek compensation. Successful claims, although relatively modest, have been found to have a significant benefit to the well being of patients who are often elderly and living off their pensions. Conflicts our patients have served in are documented together with examples of pathology and compensation given. We would like more units to
Posters / British Journal of Oral and Maxillofacial Surgery 48 (2010) S25–S55
consider making this part of their management routine. Does the debt to our veterans warrant pay back? P8 A review of 836 skin lesions excised from the Head and Neck region between March 2001 and June 2009 in the Department of Oral and Maxillofacial Surgery Department at Rotherham NHS Foundation Trust. C. Pace, R. Crosher. Rotherham Foundation Trust, UK Aim: To review the sites involved by skin lesions of the head and neck, the pathology of these lesions and the methods used to reconstruct the surgical defects. Method: Data collected prospectively on all patients undergoing surgery for head and neck skin lesions between March 2001 and June 2009. All lesions were excised by or under the direct supervision of a single surgeon. Results: 72% of skin lesions were malignant whilst 28% were benign of which 55% required reconstruction with local flaps or full thickness skin grafts. These results confirm the importance of the Oral and Maxillofacial Surgeons in the management of skin lesions in the Head and Neck. P9 Outcomes in surgical management of primary squamous cell carcinoma of the scalp in a district general hospital M.W.S. Ho, B. Elwazani, F. Farrukh, D.C. Jones. Arrowe Park Hospital, Wirral University Teaching Hospitals NHS Trust, UK The scalp is the one of the commonest subsites to develop cutaneous squamous cell carcinoma in the head and neck. Surgical management is the treatment of choice where possible. We report a retrospective analysis, looking at the surgical and pathological details, complications and, risk of regional and distant metastasis. Surgical details: 51 consecutive patients were identified from 2005–2009, who had primary surgery for primary SCC of the scalp. 65% of the surgical defects were reconstructed with local flaps, 31% with skin grafts and 4% were closed primarily. Pressure dressings were used in the early postoperative phase in 69% of patients and this appeared to be associated with a lower infection/dehiscence rate. Surgical pathology: SCC differentiation: well differentiated 31%, moderately differentiated 51% and poorly differentiated 18%. The mean size of the specimen was 39.9 mm2. None of the cases had clinical neck disease on presentation. The rate of incomplete tumour excision was 8% (all underwent further excision). Recurrence/survival: One patient developed local recurrence. 6% (n = 3) developed regional metastasis. All 3 patients had involved/close (<1 mm) deep margins, one also had involved peripheral margins. The overall survival in this group was 92% (median follow-up 14 months). Conclusion: Primary cutaneous SCC of the scalp has a low risk of regional recurrence in this group of patients. There did not appear to be a direct correlation between regional recurrence and, tumour differentiation or tumour size in our study. However all of them had close/involved deep margins. P10 Are regular reviews for recurrence warranted following oral squamous cell carcinoma resection? R. Banks, P. Docherty, M.L. Goodson. Sunderland Royal Hospital, UK Aims: To assess whether regular reviews following oral squamous cell carcinoma (OSCC) resection are warranted.
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Introduction: OSCC patients are typically followed up in secondary care for 5 years post surgery, initially on a weekly or monthly basis and later 3–6 monthly to detect recurrence. There are no standard protocols for follow up and in an attempt to develop an evidence based strategy that will inevitably have to take account of time and cost for multiple appointments and investigations, for our local population, an audit of factors relating to OSCC recurrence was undertaken. Methods: Retrospective review of patient notes from 492 OSCC’s surgically managed over a 10 year period at Sunderland Royal Hospital was carried out. Time to recurrence, characteristics surrounding referral for recurrence, treatment and survival following recurrence was recorded for each case. Results: 79 patients in this cohort had OSCC recurrence, but records were only available for 44. 56% recurrences were detected at routine appointments and the remainder expedited by self referral, GP/GDP or other medical specialties. Mean time to presentation after awareness of symptoms was 4 weeks (range 0–24 weeks). Pain (28%) was the most common symptom prompting referral. 59% recurrences were detected within 12 months and 78% within 2 years. Survival rates post recurrence were 10 months (50% patients) which increased to a mean of 22.3 months for those whose recurrence was detected at routing follow up. Conclusions: Review appointments are most warranted in years 1 and 2, but review is not terribly effective in influencing survival. P11 Tissue autofluorescence – an aid to excision margins in oral precancer surgery P. Thomson, M.L. Goodson, A. Diajil, P. Sloan. Newcastle University, UK Aim: To assess the usefulness of tissue autofluorescence in guiding laser excision margins during oral precancer surgery. Introduction: Oral precancer patients exhibit widespread field change so that clinically normal looking mucosa may harbour significant histopathological dysplasia complicating surgical excision. Tissue autofluorescence systems such as Velscope® reveal dysplastic or neoplastic tissue as dark/black against green normal mucosa background. Method: Following ethical approval and informed patient consent, 30 consecutive patients undergoing interventional laser surgery for histopathologically confirmed dysplastic oral precancer lesions at the Maxillofacial Unit in Newcastle were recruited. A standard interventional management protocol was followed, but all lesions were also examined by Velscope® in theatre immediately before excision using clinical margin only. Differences between clinical and Velscope® appearance were documented. Histopathological review of clinical excision margins were compared to Velscope® examination. Results: 30 dysplastic lesions were examined with Velscope® . Clinical margins were clear in 25 patients and involved with lesser degrees of dysplasia in 5 cases, but all margins underwent laser vaporization post lesion excision. Velscope® margins differed from clinical margins in 28 cases extending a mean of 2.3 mm past the clinical excision margin, but were similar in 2 cases where lesions were completely excised using clinical margins. Conclusions: Velscope® may be a useful adjunct to visual examination in deciding surgical excision margins, but larger studies are required to verify this.
Posters / British Journal of Oral and Maxillofacial Surgery 48 (2010) S25–S55
Results: 5 cases of facial lipodystrophy were treated with cheek and zygomatic area augmentation. 3 cases were treated for hemifacial atrophy. 1 case was treated for nasolabial fold correction. 1 patient had excision for a teratoma with resultant deformity and had been reconstructed previously with Radial forearm free flap and face lifts. 1 patient had neurofibromatosis in which the fat graft was unsuccessful. Good results were obtained using this technique with no major complications. Conclusions: Autologous fat transfer using the Colemans technique for facial soft tissue asymmetry is a safe and reliable technique. We recommend autologous fat transfer as a definitive or adjunctive treatment for facial soft tissue asymmetry. P4 Assessing the modes of saliva collection in irradiated oral cancer patients H. Kaur, A. Matthews, J. Risk, R. Shaw. University of Liverpool, UK Introduction: Early detection and treatment of oral cancer is essential in improving prognosis. Molecular biomarkers found in saliva can be used to predict, detect and monitor malignant transformation. Furthermore, with a local recurrence rate of 10%, and many of the oral cavity sites being disfigured after surgical treatment; many second primaries will go undetected. Therefore surveillance using genetic biomarkers in saliva is very appealing. Aim: To determine the most efficient mode of collecting saliva, giving a substantial yield and quality of DNA; from a population irradiated oral cancer patients. This group had demonstrated difficulty in providing saliva samples in the past due to xerostomia. Materials and Method: We investigated a new collection technique to this field; an oragene saliva sponge kit. Saliva was also collected using a mouthwash. Both collection methods were tested on 25 subjects. DNA was extracted using Oragene purifier and Qiagen columns, respectively. The two methods of saliva collection were compared using spectrophotometery, gel electrophoresis and polymerase chain reaction (PCR) amplification with b-actin primers. Results: The oragene sponge method provided a greater DNA yield (12.34 mg median) compared to the mouthwash (6.015 mg median). However, gel electrophoresis showed the mouthwash provided samples of a better quality. Both methods provided high molecular weight DNA, but the mouthwash samples contained lower free nucleotides and RNA contamination compared to the sponge samples. DNA from both methods showed the ability to produce PCR products. Conclusion: The oragene sponge method was the most efficient way of collecting saliva, from a population of irradiated oral cancer patients. P5 Dental management of head and neck radiotherapy patients H. Anziani, A. Burns, R.J. Banks. Sunderland Royal Hospital, UK Introduction: Radiotherapy can result in significant oral side effects and complications. The management of dental disease is more complicated and problems can cause a significant impact on quality of life. Therefore it is vital that all patients are rendered dentally fit prior to radiotherapy, receive sufficient preventative care and are closely followed up. Methods: A national survey was undertaken of all head and neck units in the UK to assess dental management for these patients. This
was augmented with a review locally of patients attending Sunderland Royal Hospital Head and Neck centre over a one year period. Patients were assessed via questionnaire to establish their experiences of dental care pre, peri and post radiotherapy treatment. MDT notes and radiographs were correlated with any recorded pre and post radiotherapy dental pathology, prevention and intervention. Results: The majority of patients at our centre received a dental assessment prior to commencement of their oncology treatment. Post treatment dental care of these patients is very variable. Results of our survey suggest that this pattern is reflected nationally. There would appear to be a correlation between the initial state of their dentition, their compliance, access to dental care and the post treatment morbidity suffered. Conclusion: Head and neck cancer patients often present with a neglected dentition. Dental care can be a challenge in terms of patient motivation, access, both physical and organisational with limited time available prior to treatment. This study highlights both the lack of dental care for these patients and highlights its importance. P6 Can early detection rates for cancer referred to an Oral and Maxillofacial Surgery Department be improved by consultant triage of referral letters? J. Breeze, V. Attargekar, C.E. Moss, A.J. Gibbons. Peterborough District General Hospital, UK Aim: To analyse the detection rate of oral cancer from referrals to our department and if our department policy of triaging referrals was appropriate. Material and Methods: The authors reviewed all oral cancer referrals and urgent oral lesion referrals to the Department of Oral and Maxillofacial Surgery at Peterborough and Stamford NHS Foundation Trust Hospitals during 2006. Results: 63 patients were referred in 2006 for lesions that consultant triage suspected may be malignant or referred to be seen urgently. 33 patients were referred by General Practitioners and all were subsequently seen within the 2-week rule. Consultant triage of referral letters allocated a further 17 to been seen under the 2-week rule timescale. An additional 13 urgent referrals were classified as not meeting the 2-week rule criteria by the consultant that graded the letter but to be seen within four weeks. Conclusion: Our study shows that with consultant triaging of referral letters a malignancy detection rate of 24% can be achieved. P7 Veterans:UK and skin cancer. Pay back time? R. Pilcher, M.J.C. Davidson, M. Blanco-Guzman, J.F. Hamlyn, G.D. Merrick. Musgrove Park Hospital, Taunton, UK We aim to raise awareness for a compensation scheme for exservice personnel. Skin damage resulting from excessive sun exposure during their military service abroad may manifest itself many years later. Squamous cell carcinoma, basal cell carcinoma and melanoma arising in later life are part of the price veterans may pay for having served their country. At Musgrove Park Hospital, Taunton we routinely ask about previous military service abroad and hand out when appropriate the Veterans:UK pamphlets. These have the information required to gain advice and seek compensation. Successful claims, although relatively modest, have been found to have a significant benefit to the well being of patients who are often elderly and living off their pensions. Conflicts our patients have served in are documented together with examples of pathology and compensation given. We would like more units to
Posters / British Journal of Oral and Maxillofacial Surgery 48 (2010) S25–S55
consider making this part of their management routine. Does the debt to our veterans warrant pay back? P8 A review of 836 skin lesions excised from the Head and Neck region between March 2001 and June 2009 in the Department of Oral and Maxillofacial Surgery Department at Rotherham NHS Foundation Trust. C. Pace, R. Crosher. Rotherham Foundation Trust, UK Aim: To review the sites involved by skin lesions of the head and neck, the pathology of these lesions and the methods used to reconstruct the surgical defects. Method: Data collected prospectively on all patients undergoing surgery for head and neck skin lesions between March 2001 and June 2009. All lesions were excised by or under the direct supervision of a single surgeon. Results: 72% of skin lesions were malignant whilst 28% were benign of which 55% required reconstruction with local flaps or full thickness skin grafts. These results confirm the importance of the Oral and Maxillofacial Surgeons in the management of skin lesions in the Head and Neck. P9 Outcomes in surgical management of primary squamous cell carcinoma of the scalp in a district general hospital M.W.S. Ho, B. Elwazani, F. Farrukh, D.C. Jones. Arrowe Park Hospital, Wirral University Teaching Hospitals NHS Trust, UK The scalp is the one of the commonest subsites to develop cutaneous squamous cell carcinoma in the head and neck. Surgical management is the treatment of choice where possible. We report a retrospective analysis, looking at the surgical and pathological details, complications and, risk of regional and distant metastasis. Surgical details: 51 consecutive patients were identified from 2005–2009, who had primary surgery for primary SCC of the scalp. 65% of the surgical defects were reconstructed with local flaps, 31% with skin grafts and 4% were closed primarily. Pressure dressings were used in the early postoperative phase in 69% of patients and this appeared to be associated with a lower infection/dehiscence rate. Surgical pathology: SCC differentiation: well differentiated 31%, moderately differentiated 51% and poorly differentiated 18%. The mean size of the specimen was 39.9 mm2. None of the cases had clinical neck disease on presentation. The rate of incomplete tumour excision was 8% (all underwent further excision). Recurrence/survival: One patient developed local recurrence. 6% (n = 3) developed regional metastasis. All 3 patients had involved/close (<1 mm) deep margins, one also had involved peripheral margins. The overall survival in this group was 92% (median follow-up 14 months). Conclusion: Primary cutaneous SCC of the scalp has a low risk of regional recurrence in this group of patients. There did not appear to be a direct correlation between regional recurrence and, tumour differentiation or tumour size in our study. However all of them had close/involved deep margins. P10 Are regular reviews for recurrence warranted following oral squamous cell carcinoma resection? R. Banks, P. Docherty, M.L. Goodson. Sunderland Royal Hospital, UK Aims: To assess whether regular reviews following oral squamous cell carcinoma (OSCC) resection are warranted.
S27
Introduction: OSCC patients are typically followed up in secondary care for 5 years post surgery, initially on a weekly or monthly basis and later 3–6 monthly to detect recurrence. There are no standard protocols for follow up and in an attempt to develop an evidence based strategy that will inevitably have to take account of time and cost for multiple appointments and investigations, for our local population, an audit of factors relating to OSCC recurrence was undertaken. Methods: Retrospective review of patient notes from 492 OSCC’s surgically managed over a 10 year period at Sunderland Royal Hospital was carried out. Time to recurrence, characteristics surrounding referral for recurrence, treatment and survival following recurrence was recorded for each case. Results: 79 patients in this cohort had OSCC recurrence, but records were only available for 44. 56% recurrences were detected at routine appointments and the remainder expedited by self referral, GP/GDP or other medical specialties. Mean time to presentation after awareness of symptoms was 4 weeks (range 0–24 weeks). Pain (28%) was the most common symptom prompting referral. 59% recurrences were detected within 12 months and 78% within 2 years. Survival rates post recurrence were 10 months (50% patients) which increased to a mean of 22.3 months for those whose recurrence was detected at routing follow up. Conclusions: Review appointments are most warranted in years 1 and 2, but review is not terribly effective in influencing survival. P11 Tissue autofluorescence – an aid to excision margins in oral precancer surgery P. Thomson, M.L. Goodson, A. Diajil, P. Sloan. Newcastle University, UK Aim: To assess the usefulness of tissue autofluorescence in guiding laser excision margins during oral precancer surgery. Introduction: Oral precancer patients exhibit widespread field change so that clinically normal looking mucosa may harbour significant histopathological dysplasia complicating surgical excision. Tissue autofluorescence systems such as Velscope® reveal dysplastic or neoplastic tissue as dark/black against green normal mucosa background. Method: Following ethical approval and informed patient consent, 30 consecutive patients undergoing interventional laser surgery for histopathologically confirmed dysplastic oral precancer lesions at the Maxillofacial Unit in Newcastle were recruited. A standard interventional management protocol was followed, but all lesions were also examined by Velscope® in theatre immediately before excision using clinical margin only. Differences between clinical and Velscope® appearance were documented. Histopathological review of clinical excision margins were compared to Velscope® examination. Results: 30 dysplastic lesions were examined with Velscope® . Clinical margins were clear in 25 patients and involved with lesser degrees of dysplasia in 5 cases, but all margins underwent laser vaporization post lesion excision. Velscope® margins differed from clinical margins in 28 cases extending a mean of 2.3 mm past the clinical excision margin, but were similar in 2 cases where lesions were completely excised using clinical margins. Conclusions: Velscope® may be a useful adjunct to visual examination in deciding surgical excision margins, but larger studies are required to verify this.